Provider Demographics
NPI:1972314581
Name:DE KOKER, KAYLEIGH (MS, LAT, ATC)
Entity type:Individual
Prefix:MS
First Name:KAYLEIGH
Middle Name:
Last Name:DE KOKER
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CRAWFORD ST APT 407
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4657
Mailing Address - Country:US
Mailing Address - Phone:423-331-8848
Mailing Address - Fax:
Practice Address - Street 1:401 N 4TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47809-1934
Practice Address - Country:US
Practice Address - Phone:808-651-3042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36003900A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer